Critical Review:
Nicotine for the Fetus, the Infant and the Adolescent?

For more than 20 years 'Nicotine Replacement Therapy' (NRT) for smoking
cessation has been expanding with more forms of application and new indications
for use. However, the evidence shows that long-term success has been weak or
altogether absent with high levels of relapse to smoking. Indefinite continuing
use of NRT has been deemed preferable to continued smoking. Last year, the
National Health Service in the UK extended the use of NRT to pregnancy, to
children from age twelve, and advocated NRT use even while still smoking.
Similar trends are discernible in the US and Europe. In light of this growing
emphasis on NRT, nicotine had to be made palatable by playing down or even
denying its toxicity and declaring it "as innocent as caffeine."

This Critical Review, published in the Journal of Health Psychology takes
issue with the grave risk of this irresponsible policy especially for the newly
added target population. Nicotine interacts with the very basic functions of the
peripheral and central nervous system, i.e., the nerves supplying organs and
tissues of the body and the vital command stations in the brain. When these
systems are formed during fetal life, nicotine from the mother exposed to
smoking, secondhand smoke, or NRT can critically impair their normal
development.

Perinatal nicotine exposure has been implicated in 'Sudden Infant Death
Syndrome' (SIDS), in 'Attention Deficit Hyperactivity Disorder' (ADHD), in
affective and behavioral problems, cognitive and learning deficits, depression
and nicotine addiction in adolescence.

In the amounts ingested from smoking or NRT, nicotine also plays a prominent
role in tobacco-related carcinogenesis, in the incidence of cardiovascular
disease, pulmonary emphysema, kidney disease, stomach and duodenal ulcers, and
macula degeneration.

Tobacco control must be nicotine control. Without nicotine control, nicotine
addiction and nicotine's multifarious impact on the user would persist and
spread at the peril of the unborn, the next generation, and public health in
general.

Nicotine Fix - Behind Antismoking Policy, Influence of Drug Industry - A February 8, 2007 front page article in the Wall Street Journal by Pulitzer Prize winning journalist Kevin Helliker reviews how NRT has not proven effective in real-world use yet leadership at the U.S. Agency for Healthcare Research and Quality is allowing a number of experts with financial ties to pharamaceutical industry smoking cessation products to hold positions on an expert panel that is currently engaged in rewriting U.S. cessation policy, including the panel's chairman.

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